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1972133254
SHAZAM BACCHUS
NEWARK, NJ
NPI
1972133254
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP2300X Nurse Practitioner Primary Care
(Licence: NJ 26NJ01004000)
Enumeration Date
2020-01-24
Last Update Date
2020-01-24
Business Address
SHAZAM BACCHUS APN
459 N 7TH ST FL 1
NEWARK, NJ 07107-3743
Phone number: 973-388-9560
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Mailing Address
SHAZAM BACCHUS APN
459 N 7TH ST FL 1
NEWARK, NJ 07107-3743
Phone number: 973-388-9560
Copy
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